Religious Commitment as a Predictor of Lower Blood Pressure

117 Pages·2015·0.6 MB·English

by  Anna Vadimovna Ermakova

East Tennessee State University
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Tennessee State University
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5-2011
Religious Commitment as a Predictor of Lower
Blood Pressure in High-Risk Pregnancies of
Southern Appalachia.
Anna Vadimovna Ermakova
East Tennessee State University
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Ermakova, Anna Vadimovna, "Religious Commitment as a Predictor of Lower Blood Pressure in High-Risk Pregnancies of Southern
Appalachia." (2011).Electronic Theses and Dissertations.Paper 1264. https://dc.etsu.edu/etd/1264
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Religious Commitment as a Predictor of Decreased Blood Pressure
in High-Risk Pregnancies of Southern Appalachia
______________________________________

A thesis
presented to
the faculty of the Department of Psychology
East Tennessee State University

In partial fulfillment
of the requirements for the degree
Master of Arts in Psychology
________________________________________

by
Anna Vadimovna Ermakova
May 2011
________________________________________
Dr. Andrea Clements, Chair
Dr. Beth Bailey
Dr. William Dalton

Keywords: Religiosity, Religious Commitment, Blood Pressure, Pregnancy
ABSTRACT

Religious Commitment as a Predictor of Lower Blood Pressure
in High-Risk Pregnancies of Southern Appalachia

by

Anna Vadimovna Ermakova

Extensive literature review inspired a mediational model of the relationship between
Religiosity/Spirituality (R/S) and Blood Pressure (BP) tested through secondary analyses of data
from the TIPS program. Participants included 205 (92.1% Caucasian; age M=23.72, SD=5.33)
pregnant Southern Appalachian women drawn from the region‘s at-risk pregnancy population.
The only variables correlated with BP were women‘s weight (r=.430, r=.467, p<.01, for diastolic
and systolic BP, respectively) and prenatal care use (r=.138, p<.05, with diastolic BP), but not
R/S. Multiple regression analyses confirmed participant weight as the only significant
independent predictor of BP. Previous findings of health benefits of R/S cannot be assumed to
generalize to pregnant women without further study. Limitations of this study and possible
explanations for the findings are discussed.
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CONTENTS

Page
ABSTRACT ........................................................................................................................ 2
LIST OF TABLES ................................................................................................................. 6
LIST OF FIGURES ............................................................................................................... 7

Chapter
1. INTRODUCTION ............................................................................................................. 8
2. LITERATURE REVIEW .................................................................................................. 10
Impact and Predictors of High Blood Pressure in Pregnancy ........................................ 10
Risks Related to High Blood Pressure in Pregnancy ............................................... 10
High Blood Pressure as a Risk Factor for the Mother ................................... 11
High Blood Pressure as a Risk Factor for the Child ...................................... 11
High Blood Pressure and Stress ..................................................................... 13
Predictors of High Blood Pressure in Pregnancy ..................................................... 14
Pregnancy Risk Factors in Southern Appalachia ..................................................... 14
Religiosity-Health Relationship ..................................................................................... 16
Religiosity-Health Research ..................................................................................... 16
Religiosity-Health Pathways .................................................................................... 17
Health Behaviors ............................................................................................ 17
Social Support ................................................................................................ 18
Psychological Resources ................................................................................ 19
Religiosity-Health Research Model ......................................................................... 21
Religiosity-Blood Pressure Relationship .................................................................. 22
Religiosity-Blood Pressure Research Model ............................................................ 26
Health-Related Measurement of Religiosity/Spirituality ............................................... 28
3
Chapter Page
Development of Religiosity/Spirituality Measures .............................................. 28
Operationally Defining Religiosity/Spirituality ................................................... 29
Brief Multidimensional Measurement of Religiousness/Spirituality (BMMRS) 31
Intrinsic Orientation ....................................................................................... 31
Collaborative Religious Coping ..................................................................... 33
Church Attendance......................................................................................... 36
Private Prayer ................................................................................................. 38
Religious Support........................................................................................... 39
Other Religiosity/Spirituality Measures ........................................................ 40
3. METHODS ................................................................................................................... 44
Population ................................................................................................................. 44
Procedure ................................................................................................................... 45
Collection of Original Data .................................................................................. 45
Secondary Data Preparation Procedure ............................................................... 46
Instruments ................................................................................................................. 46
Brief Multidimensional Measurement of Religiousness/Spirituality (BMMRS) 47
Smoking Questionnaire ........................................................................................ 49
Kessner Adequacy of Prenatal Care Utilization Index ........................................ 50
Prenatal Psychosocial Profile (PPP) .................................................................... 50
Background Information ...................................................................................... 51
Medical Charts ..................................................................................................... 52
Data Analysis Plan ..................................................................................................... 52
4. RESULTS ...................................................................................................................... 55
5. DISCUSSION ................................................................................................................ 68
Study Limitations ....................................................................................................... 72
Study Implications and Future Research ................................................................... 74
4
Chapter Page
REFERENCES ...................................................................................................................... 76
APPENDICES ....................................................................................................................... 94
Appendix A: BMMRS .............................................................................................. 94
Appendix B: Summary of the BMMRS Measures Not Included in the Study .......... 98
Appendix C: Background Information Form ............................................................ 100
Appendix D: Pregnancy Smoking Information Questionnaire for Smokers ............. 104
Appendix E: Pregnancy Smoking Information Questionnaire for Nonsmokers ....... 111
Appendix F: Prenatal Psychosocial Profile................................................................ 113
Appendix G: Kessner Adequacy of Prenatal Care Utilization Index ........................ 115
VITA ………........................................................................................................................ 116

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LIST OF TABLES
Table Page
1. Comparison of Total Sample and Study Sample by Demographic Variables ........... 44
2. Sample Descriptive Statistics by Study Variables ..................................................... 55
3. Bivariate Correlations Among Predictor Variables ................................................... 56
4. Bivariate Correlations Among Mediators and Control Variables .............................. 57
5. Bivariate Correlations Among Predictors and Mediators, Controls .......................... 58
6. Bivariate Correlations Among Outcome and Predictor Variables ............................. 58
7. Bivariate Correlations Among Outcome Variables and Mediators, Controls ........... 59
8. Multiple Regression Results with Religious Attendance as Predictor, Diastolic BP
as Outcome................................................................................................................. 60
9. Multiple Regression Results with Religious Attendance as Predictor, Systolic BP
as Outcome................................................................................................................. 60
10. Multiple Regression Results with Collaborative Coping as Predictor, Diastolic BP
as Outcome................................................................................................................. 62
11. Multiple Regression Results with Collaborative Coping as Predictor, Systolic BP
as Outcome................................................................................................................. 62
12. Multiple Regression Results with Intrinsic Orientation as Predictor, Diastolic BP
as Outcome................................................................................................................. 64
13. Multiple Regression Results with Intrinsic Orientation as Predictor, Systolic BP
as Outcome................................................................................................................. 64
14. Multiple Regression Results with Religious Commitment as Predictor, Diastolic
BP as Outcome ........................................................................................................... 66
15. Multiple Regression Results with Religious Commitment as Predictor, Systolic
BP as Outcome ........................................................................................................... 66
B1. Summary of the BMMRS Measures Not Included in the Study ............................... 98
6
LIST OF FIGURES
Figure Page
1. Effect of R/S on Health Outcomes............................................................................. 22
2. Effect of Religious Commitment on Blood Pressure ................................................. 28
3. Operational Definition of Religious Commitment .................................................... 42
4. Proposed Relationship of Religious Commitment to Blood Pressure (Including
Instruments) ............................................................................................................... 54

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CHAPTER 1
INTRODUCTION
Pregnancy is a decisive time both for the mother and for the developing child. The
mother‘s physiology, emotions, nutrition, and lifestyle have significant impact on the fetus that
often lasts well into the child‘s adolescent and sometimes even adult years (e.g., Barker, 1993;
Engle, Tomashek, Wallman, & the Committee on Fetus and Newborn., 2007; Moster, Lie, &
Markestad, 2008). Among the known pregnancy risk factors that predict premature birth or low
birth weight is high blood pressure, which may lead to preeclampsia or eclampsia (March of
Dimes, 2007a). It is known that higher-than-normal body mass index, smoking, age, and stress
are among factors that predict hypertension or higher blood pressure during pregnancy (e.g.,
Hixson, Gruchow, & Morgan, 1998; Leeman & Fontaine, 2008). While some actual stressors
may not be possible to eliminate, it has been demonstrated that religiously committed individuals
are less likely to experience stressors, possibly due to their healthier behaviors and/or help
provided by their religious communities (e.g., Ellison & Levin, 1998; Krause, 1999), and that the
perception of stress can be buffered via religious/spiritual belief and attitudes (e.g., Pargament et
al., 1990). If it is possible that religious commitment can eliminate some actual stressors and/or
reduce the effect of stress on health, potentially lowering the mother‘s blood pressure and
eventually impacting birth outcomes, then this hypothesis is worthy of investigation.
Multiple studies over the course of several decades have established a connection
between religiosity and/or spirituality and health (e.g., George, Larson, Koenig, & McCullough,
2000; Hill & Pargament, 2003). Although controversy exists, most researchers agree that
religious commitment, defined differently by various investigators (as described further),
predicts better health outcomes, from lower morbidity to a better immune system (e.g., Masters,
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2008; McCullough, Hoyt, Larson, Koenig, & Thoresen, 2000). With as much work as there is in
this field, Masters and Spielmans (2007) insisted that the investigation of religion‘s effect on
health needs ―empirical studies based on clear conceptual models that include precise operational
definitions and psychometrically sufficient measures‖ (p. 335). Indeed, religiosity and/or
spirituality have been measured with dozens of instruments, defined using numerous
perspectives, and hypothesized to affect health measures via different pathways, not all of which
have been based on conceptual models.
One of the goals of this study was to examine the existing religion-health literature in
order to arrive at the measures of religiosity/spirituality that would be most predictive of lower
blood pressure. The best empirically supported health-related religiosity measures were used to
operationally define religious commitment. Taking into consideration proposed paths by which
religiosity affects health, a theoretically-driven model for this study was developed. This allowed
for statistically estimating direct and indirect paths for the effect of religious commitment on
blood pressure through several mediational and direct pathways. Thus, the objective of this study
was to examine if religious commitment predicts lower blood pressure in women experiencing
high-risk pregnancies in rural southern Appalachia. Pregnancies examined for this study are
considered at-risk due to this region‘s risk factors, including low socioeconomic status, poor
education, low health literacy, high substance use, intimate partner violence, and so forth, as
described further.

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